Sports cheats will always keep their nose in front

The arms race between dopers and testers will go on despite the shaming of champion cyclist Lance Armstrong

By Chris Cooper

So it finally arrived on the electronic doorstep – the 1000-page report from the US Anti-Doping Agency outlining the case against the seven-times Tour de France winner Lance Armstrong.

For those of us in the know, the scale of the activity it exposed came as little surprise. Coordinating blood transfusions and hormone doping during a three-week race while avoiding detection requires subterfuge, careful planning and medical assistance on a massive scale. All these, and more, are outlined in the exhaustive report.

What matters now is that we learn from this episode. Can we be sure that it won’t happen again? To answer that, we need to ask why the doping went undetected for so long.

The core issue in long-distance cycling is blood doping, which means increasing the number of red blood cells in the body. The resultant increase in haemoglobin boosts the amount of oxygen in the blood and hence the rate of oxygen delivery to muscle.

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As any biochemist will tell you, the key cellular energy “currency”, the chemical known as ATP, is produced more efficiently in the presence of oxygen. Extra oxygen therefore improves performance in high-intensity aerobic events. In the Tour de France, it is most important for mountain climbers, and you can’t win the Tour without being good up the hills.

Increasing the body’s haemoglobin content can be achieved in a number of ways. The old-fashioned one is to live at altitude&colon; the lower oxygen level in the air triggers the production of the hormone erythropoietin (EPO), which stimulates bone marrow to make red blood cells.

The more modern, and likewise acceptable, way to achieve this is by living in a low-oxygen tent for a large part of the day. However, there is a limit to how high the red-blood-cell count can be raised in this way.

EPO injections

Enter Armstrong and his US Postal team. One of the methods they used is injecting EPO. There is a validated EPO test that can distinguish natural EPO from the subtly different molecule used in medicine and in sports doping, but this is one of the trickier tests to perform and, even more problematically, EPO has a short half-life in the body. To catch someone, you need to get a urine sample very soon after the drug is injected. Avoiding being tested during this window was key to Armstrong’s strategy.

Also, although EPO injections work better than living at altitude, they likewise only have a gradual effect on red-blood-cell count. To get the biggest hit before a race, you need a blood transfusion. This “blood doping” raises haemoglobin instantly, yielding an immediate performance benefit.

Unlike many alleged performance-enhancing drugs, blood doping really works. This is the carrot. Is there a stick? Can it be detected by the anti-doping agencies?

Blood doping is easier to detect than EPO – at least, it is if the doper uses somebody else’s blood. This is the sort of blood transfusion you get in hospital.

Autologous doping

Differences in the minor blood groups in a matched transfusion can be detected, though, so a few years ago athletes switched to “autologous doping” – giving themselves transfusions of their own blood. Off-season they took EPO, then had some of their blood withdrawn and refrigerated for subsequent re-injection. It is frequently the paraphernalia of blood transfusions that puts the authorities on to the scent of the doper.

So why is there a feeling that cycling has become “cleaner” in recent years? Some of the difference is in part due to an influx of teams that appear genuinely to support a cleaner sport.

There has also been the advent of the “biological passport” system, one that has caused the remaining dopers some concern. This passport is a profile of someone’s blood samples, looking at how factors such as haemoglobin content and the number of young red blood cells vary. It uses Bayesian statistics to determine the significance of any changes from an individual’s baseline.

No end to the arms race

The passport has been legally approved for indirect detection of doping using blood transfusions or EPO. However, it is not a panacea. Athletes are already changing their habits by micro-dosing with EPO, for example, to avoid sudden, suspicious changes in their blood. The arms race between doper and tester continues.

Should we despair? No more than in any other walk of life. There are cheats everywhere, not just in sport. Individuals lie on their tax returns; accountants lie to advance the companies they work for; and scientists publish doctored or even fraudulent results.

Of course cheating in sport would end if, as some have proposed, we remove all bans on doping. In my book, I argue against this extreme position. Yet we cannot make rules and expect no one to try to cheat. We can only hope that the worst cheats get caught eventually. Lance Armstrong did.

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Chris Cooper is director of sports and exercise science at the University of Essex, UK, and the author of Run, Swim, Throw, Cheat – a book about the science of doping. He regularly blogs on this topic at runswimthrowcheat.com